Dissolved Protein Arthritis Markers

ABSTRACT

Methods and kits for diagnosing arthritis are provided. The methods may involve detection of 14-3-3 eta or gamma proteins in a sera or synovial fluid sample.

CROSS-REFERENCE

This application a continuation of U.S. patent application Ser. No.12/637,730, filed Dec. 14, 2009, which is a continuation of U.S. patentapplication Ser. No. 12/300,118, filed Nov. 6, 2008, which is a NationalPhase Entry of PCT Application No. PCT/CA2007/000817, filed May 9, 2007,which claims the benefit of U.S. Provisional Application No. 60/798,712,filed May 9, 2006, each of which is incorporated herein by reference intheir entirety.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has beensubmitted in ASCII format via EFS-Web and is hereby incorporated byreference in its entirety. Said ASCII copy was created on Oct. 13, 2017,is named 177000-seq-list.txt and is 40,524 bytes in size.

FIELD OF THE INVENTION

The invention relates to assays for selected protein isoforms that arediagnostic biomarkers for arthritis when those proteins are found inextracellular fluids.

BACKGROUND OF THE INVENTION

Arthritis or arthralgia generally refers to inflammatory disorders ofthe joints of the body, and is usually accompanied by pain, swelling andstiffness. Arthritis may result from any of several causes includinginfection, trauma, degenerative disorders, metabolic disorders ordisturbances or other unknown etiologies. Arthritis may be morespecifically described as, for example, rheumatoid arthritis,osteoarthritis, bacterial or infectious arthritis. Arthritis may furtheraccompany other identified disorders, including gout, ankylosingspondylitis, inflammatory bowel disease or psoriasis.

In normal joints, a small amount of synovial fluid (SF) lubricatescartilage and the synovium, and acts as a reservoir for solutes and afew resting mononuclear and synovial cells (3). During chronicinflammation, SF volume and the concentration of immune cells andsoluble proteins increase (4).

For some forms of arthritis, such as rheumatoid arthritis (RA), thespecific cause may not be known. RA is regarded as a “multifactorialthreshold model”, in which many genetic and environmental influencesmust act on the same person in order for the disease to manifest (1). Asa specific target is lacking, current therapies are primarily aimed atsuppression of the inflammatory response (2). A hallmark of RA issynovial hyperplasia, characterized by fibroblast-like synoviocyte (FLS)proliferation and inflammatory cell infiltration into the subintima, orouter layer of the synovium (5). The FLS, which comprise abouttwo-thirds of the synovium population, have a well-defined secretorysystem (5) and secrete large amounts of destructive matrixmetalloproteases (MMPs) in RA (6), specifically MMP-1, 3, 8, 9, 10, 11and 13 (7-11). Numerous researchers have shown that MMP-1 and MMP-3 playimportant roles in RA (12) and that the collagenase (MMP-1) is the mostabundant (6). Both MMP-1 and MMP-3 are biomarkers that have been shownto have predictive validity for structural damage in RA. Localexpression of MMPs in arthritis, especially MMP-1, is particularlyprominent in the joint pannus adjacent to the site of cartilage and bonedestruction (13). The collagenases, particularly MMP-1, cleave nativecollagen molecules at neutral pH, rendering the collagen susceptible tofurther enzymatic degradation (14).

Known factors that activate FLS to produce MMP-1 includepro-inflammatory cytokines such as interleukin-1 (IL-1) and tumournecrosis factor alpha (TNF-alpha), and both are involved in RA (15).IL-1alpha and TNF-alpha are capable of stimulating the production ofother MMPs and stromelysins in synovial fibroblasts and chondrocytes invitro (16). The interactions of FLS with TNF-alpha or IL-1 alpha fromactivated T cells induces expression of MMP-1 (17). T-cells can alsoactivate FLS to produce an array of inflammatory mediators (18). Thiscyclical feedback loop between FLS and T cells and their respectivecytokines lead to activation and proliferation of T cells and favoursthe persistent inflammation observed in RA (19-21). It has beensuggested that therapeutic anti-TNF alpha antibodies neutralize TNFalpha and block the T cell activation that leads to this persistentstate (22).

14-3-3 proteins are a family of dimeric proteins involved in a range offunctions (23-24). There are seven mammalian 14-3-3 isoforms: beta (β),gamma (γ), epsilon (ε), eta (η), sigma (σ), tau (τ) and zeta (ζ). Sincethe discovery of the first 14-3-3 protein in 1967 (26), the members ofthe 14-3-3 protein family have been repeatedly re-discovered based ontheir new biological activities, primarily in signal transductionpathways. They have been identified as activators of tryptophan andtyrosine hydroxylase (27-28) and PKC inhibitors (29). Subsequent studiesidentified the 14-3-3 proteins as molecules that interact with PKCs, Raffamily members and now more than 200 other intracellular proteins withcritical biological functions (30-31) including cellular response to DNAdamage and cell cycle regulation (32-34).

SUMMARY OF THE INVENTION

The invention is based in part on the surprising discovery thatparticular isoforms of the 14-3-3 protein, 14-3-3 eta and gamma, arepresent at increased levels in the serum and synovial fluid of arthritispatients, compared to normal patients.

In accordance with one aspect of the invention, there is provided amethod for predicting responsiveness of a subject to a therapeuticregimen, the subject having, or suspected of having arthritis, themethod comprising determining a presence, absence, amount or relativelevels of a protein 14-3-3 eta or gamma in a sample, wherein thepresence, absence, amount or relative level of the isoform is indicativeof a sensitivity of the subject's arthritis to the therapeutic regimen.

In accordance with another aspect of the invention, there is provided akit for detecting a 14-3-3 eta or gamma protein in a patient sample,such as a sample of sera or synovial fluid from a patient having, or atrisk of having, an arthritis. The kit may comprise at least one antibodyspecific for detecting at least one of these isoforms of the 14-3-3protein. The kit may further comprise at least one antibody specific fordetecting at least one matrix metalloproteinase.

In accordance with another aspect of the invention, there is provided amethod for selecting a group of subjects for determining the efficacy ofa therapeutic regimen known or suspected of being useful for thetreatment of arthritis, the method comprising detecting a presence,absence, amount or relative levels of a 14-3-3 eta or gamma protein in apatient sera or synovial fluid sample, wherein said presence, absence,amount or relative level of one or more of these isoforms of the 14-3-3protein in that fluid is indicative of a sensitivity of the subject'sarthritis to the therapeutic regimen.

In accordance with another aspect of the invention, there is provided amethod of treating arthritis in a mammalian subject in need thereof, themethod comprising administering to the subject a therapeutic regimen,wherein the presence, absence, amount or relative level of a 14-3-3 etaor gamma protein isoform in sera or synovial fluid from that subject isindicative of sensitivity to the therapeutic regimen.

In accordance with another aspect of the invention, there is provided amethod of treating arthritis in a mammalian subject in need thereof, themethod comprising: selecting a subject having a presence, absence,amount or relative level of 14-3-3 eta or gamma protein in sera orsynovial fluid that is indicative of sensitivity to a therapeuticregimen; and administering to the subject the therapeutic regimen.

In accordance with another aspect of the invention, there is provided amethod of identifying a mammalian subject with an increased sensitivityto a therapeutic regimen for treating arthritis, comprising the step ofscreening a population of subjects for the presence, absence, amount orrelative level of 14-3-3 eta or gamma protein in sera or synovial fluid,and identifying subjects sensitive to the therapeutic regimen based atleast in part on the presence, absence, amount or relative level of theprotein in the fluid.

In selected embodiments, the invention may involve assays for otherarthritis markers in the sera or synovial fluids of subjects, inconjunction with assays for the presence, absence, amount or relativelevel of 14-3-3 eta or gamma proteins. For example, assays of theinvention may additionally involve determining the presence, absence,amount or relative levels of one or more matrix metalloproteinases, suchas MMP-1 or MMP-3, in sera or synovial fluid samples.

BRIEF DESCRIPTION OF THE DRAWINGS

In drawings which illustrate embodiments of the invention,

FIG. 1

Detection of various isoforms of 14-3-3 in the synovial fluid (SF) andserum (PS) of arthritic patients by western blot. Keratinocyte lysates(K) was used as a positive control.

FIG. 2.

Detection of 14-3-3η in the synovial fluid of 17 arthritic patients.Synovial fluid samples (2 μl/lane) were taken from 17 RA patients whohad active synovitis and analyzed by western blot, using anisoform-specific antibody for the 14-3-3η isoform. Keratinocyte lysate(K) was used as a positive control. Levels of 14-3-3η vary in thepatient population surveyed, but is reliably detected in all synovialfluid samples.

FIG. 3

14-3-3η, MMP-1 and MMP-3 expression in patient sera and synovial fluid.12 patients' matched synovial fluid and serum samples examined bywestern blot. Keratinocyte cell lysate (K) was used as a positivecontrol. SF: synovial fluid; PS: patient serum; MMP-1: matrixmetalloproteinase 1; MMP-3: matrix metalloproteinase 3.

FIG. 4

Detection and comparison of the levels of 14-3-3η and γ in 9 matchedpatient serum and synovial fluid samples. Patients' synovial fluid orserum (2 μl/lane) was analyzed by western blot using anti 14-3-3η or γantibody. Keratinocyte cell lysate (K) was used as a positive control.SF, synovial fluid; PS, patient serum.

FIG. 5

Levels of 14-3-3η in matched patient serum and synovial fluid sampleswere quantified by densitometry and depicted in lower panel. Solid barsshow the level of 14-3-3η in serum normalized to a synovial fluid samplefrom the same patient (open bars).

FIG. 6A-B

Detection of 14-3-3η, γ, MMP-1 and MMP-3 in different volumes of normaland patients sera.

A) Pooled samples of 12 normal or patient sera were prepared and a rangeof volumes (0.1-2.0 μl/lane) were analyzed by western blot, usingspecific antibodies for 14-3-3η, γ, MMP-1 or MMP-3. 2 μl of a pooled ofsynovial fluid (SF) from affected patients was included as a positivecontrol. B) Recombinant 14-3-3η isoform (0.01-2.0 μg/lane) was analyzedby western blot in parallel with 2 μl of normal (NS) or patient serum(PS).

FIG. 7

Illustrates detection of 14-3-3η before and after anti-TNF therapy:Levels of 14-3-3 eta protein in 4 ml of serum samples from RA patientsbefore (U) and after anti-TNF-a (T) Treatment. N=negative control whichis 4 ml of a pooled serum sample prepared from 12 serum samples takenfrom 12 healthy individuals. P=positive control which is 4 mg ofkeratinocyte cell lysate total protein.

DETAILED DESCRIPTION

A “Disease Activity Score” (DAS) refers to a measure of the activity orstate of rheumatoid arthritis in a patient. DAS is one of severalstandards or scores used in clinical practice. A calculation of a DASmay include the following parameters:

Number of joints tender to the touch (TEN), number of swollen joints(SW), erythrocyte sedimentation rate (ESR) and patient assessment ofdisease activity (VAS). Alternatively, a DAS may include C-reactiveprotein marker assessment (CRP) (Skogh T et al 2003. Ann Rheum Dis62:681-682).

A patient or test subject, as used herein, includes a human patientundergoing, or about to undergo, treatment for arthritis. A test subjectincludes non-human mammals undergoing, or about to undergo, treatmentfor arthritis. In the case of a test subject, the arthritis may bedeliberately induced or implanted, or may develop spontaneously. Thepatient or test subject may have been previously diagnosed using methodsdescribed herein, for example, or other diagnostic methods known in theart, or may be selected as part of general population (a ‘control’patient or ‘control’ test subject). Patients and test subjects, whethercontrol or not, may be generally referred to as a subject. Patients maybe selected or differentiated on the basis of disease severity, gender,age, or suitability for a particular treatment or assay method.

As used herein, an ‘isoform’ refers to any two or more of functionallysimilar proteins that have a similar but not identical amino acidsequence and are either encoded by different genes or by RNA transcriptsfrom the same gene which have had different exons removed.

It will be appreciated by a person of skill in the art that thenumerical designations of the positions of nucleotides or amino acidswithin a sequence are relative to the specific sequence. Also, the samepositions may be assigned different numerical designations depending onthe way in which the sequence is numbered and the sequence chosen.Furthermore, sequence variations such as insertions or deletions, maychange the relative position and subsequently the numerical designationsof particular nucleotides or amino acids at or around a particular site.

The terms ‘peptide’, ‘polypeptide’ and protein' may be usedinterchangeably, and refer to a compound comprised of at least two aminoacid residues covalently linked by peptide bonds or modified peptidebonds, for example peptide isosteres (modified peptide bonds) that mayprovide additional desired properties to the peptide, such as increasedhalf-life. A peptide may comprise at least two amino acids. The aminoacids comprising a peptide or protein described herein may also bemodified either by natural processes, such as posttranslationalprocessing, or by chemical modification techniques which are well knownin the art. Modifications can occur anywhere in a peptide, including thepeptide backbone, the amino acid side-chains and the amino or carboxyltermini. It is understood that the same type of modification may bepresent in the same or varying degrees at several sites in a givenpeptide.

Nomenclature used to describe the peptide compounds of the presentinvention follows the conventional practice where the amino group ispresented to the left and the carboxy group to the right of each aminoacid residue. In the sequences representing selected specificembodiments of the present invention, the amino- and carboxy-terminalgroups, although not specifically shown, will be understood to be in theform they would assume at physiologic pH values, unless otherwisespecified. In the amino acid structure formulae, each residue may begenerally represented by a one-letter or three-letter designation,corresponding to the trivial name of the amino acid.

The term ‘antibody’ as used herein includes polyclonal and monoclonalantibodies, chimeric, single chain, or humanized antibodies, as well asFab or F(ab)² fragments, including the products of an Fab or otherimmunoglobulin expression library. Methods of making such antibodies orfragments are known in the art and may be found in, for example HARLOW,E and LANE D. Antibodies: A Laboratory Manual. 1988. Cold Spring HarborLaboratory Press. Selection or identification of specific peptides foruse as epitopes for production of antibodies that differentiate betweenproteins, or isoforms of proteins may be made using sequencecomparisons—one of skill in the art will be able to identify suitablepeptide or protein sequences that may be useful for producing antibodieswith the desired selectivities. Examples of sequences that may be usefulto one of skill may include SEQ ID NOs: 1-7.

As used herein, ‘arthritis’ or ‘arthralgia’ refer to an inflammatorydisorder of the joints of the body. Pain, swelling, stiffness anddifficulty of movement are frequently associated with arthritisdiseases. Arthritis may result from any of several causes includinginfection, trauma, degenerative disorders, metabolic disorders ordisturbances or other unknown etiologies. Arthritis may be morespecifically described as, for example, rheumatoid arthritis,osteoarthritis, bacterial or infectious arthritis. Arthritis may furtheraccompany other identified disorders, including gout, ankylosingspondylitis, inflammatory bowel disease or psoriasis.

14-3-3 proteins, particularly the eta and gamma isoforms, may be readilydetected in synovial fluid or serum of patients affected with arthritis,for example rheumatoid arthritis. In one embodiment of the invention,detection of these signal transduction proteins in the site ofinflammation may have application in early or more simplified diagnosisof arthritis, or differentiation between the various types of arthritisin a patient. Alternatively, the presence or relative levels of isoformsof 14-3-3 proteins may be a prognostic indicator of early-stagearthritis, before it progresses to a debilitating form. An advantage ofearly prognosis or diagnosis is earlier implementation of a treatmentregimen. Alternatively, the presence or relative levels of isoforms of14-3-3 in a patient sample may be useful to determine patientsuitability for a particular treatment regimen.

Treatment regimens for various types of arthritis are known in the art.Therapeutic approaches to arthritis may for example be generallycharacterised as disease modifying therapy for arthritis, or remittivetherapies. For example, a patient diagnosed with rheumatoid arthritismay be prescribed non-steroidal anti-inflammatory medications (NSAIDs)initially, to ease the discomfort and reduce the inflammation. Othertreatment regimens may include, for example cyclooxygenase 2 specificinhibitors (CSIs), glucocorticoids, disease-modifying anti-rheumaticdrugs (DMARDs), anti-TNF alpha neutralizing agents or immunosuppressiveor cytotoxic drugs. Details on dosage or examples of particular drugswill be known to those of skill in the art, and may be found in, forexample Harrison's Principles of Internal Medicine 15^(th) ed. BRAUNWALDet al eds. McGraw-Hill or “The Pharmacological basis of therapeutics”,10^(th) edition. HARDMAN H G., LIMBIRD L E. editors. McGraw-Hill, NewYork, and in “Clinical Oncology”, 3^(rd) edition. ChurchillLivingstone/Elsevier Press, 2004. ABELOFF, M D. editor.

In another embodiment of the invention, the presence or relative levelsof 14-3-3 eta or gamma proteins may correlate with the presence orrelative levels of other proteins in the patient sample, for examplematrix metalloproteinases (MMPs), such as MMP-1 or MMP-3. MMPs arezinc-binding endopeptidases that degrade components of the extracellularmatrix. MMPs have different substrate specificities and are encoded bydifferent genes. At least 25 different MMPs have been identified.Detection of 14-3-3 eta or gamma proteins in combination with at leastone MMP in a patient sample may have application in early or moresimplified diagnosis of arthritis, or differentiation between thevarious types of arthritis in a patient. Alternatively, the presence orrelative levels of eta or gamma isoforms of 14-3-3 proteins incombination with at least one MMP in a patient sample may be aprognostic indicator of early-stage arthritis, before the arthritisprogresses to a debilitating form. An advantage of early prognosis ordiagnosis may include earlier implementation of a treatment regimen.Alternatively, the presence or relative levels of eta or gamma isoformsof 14-3-3 in combination with at least one MMP in a patient sample maybe useful to determine patient suitability for a particular treatmentregimen.

In another embodiment of the invention, a kit for detecting the presenceof 14-3-3 eta or gamma proteins or particular MMPs in a patient sample,the kit being suitable for use in providing a diagnostic or prognosticresult suitable for diagnosing or differentiating various types ofarthritis. A kit may include, for example, antibodies specific for etaor gamma isoforms of 14-3-3 proteins. Such a kit may further includeantibodies specific for particular MMPs. The kit may further includeother reagents necessary for the detection of 14-3-3 eta or gamma orMMPs immunologically, such as labelled secondary antibodies, chromogenicor fluorogenic reagents, polymerization agents and/or instructions forusing the kit for diagnostic or prognostic purposes.

General Methods

Once a subject is identified as being at risk for developing or havingarthritis, information useful for assessing the disease state of thediagnosed arthritis, response to a therapeutic treatment regimen forarthritis, or prognosis of arthritis, or the type of arthritis may beobtained from the patient or test subject. Various methods for obtainingbiological samples from a subject that contain protein or peptides thatmay be useful as biomarkers are known in the art. For example, tissuesamples may be obtained by curettage, needle aspiration biopsy or needle(core) biopsy, incisional biopsy for sampling a tumor, or excisionalbiopsy, which may entail total removal of the tissue of interest.Alternatively, other bodily samples that contain genetic material, suchas synovial fluid, hair, sputum, urine, stool, semen, plasma, serum orblood may be collected using methods known in the art.

The presence of specific proteins or peptides in a biological sample, orthe relative levels of specific proteins or peptides in a biologicalsample may be detected by any of several methods known in the art.Examples of such methods include mass spectroscopy, immunological-basedtechniques such as western blotting, ELISA, immunohistochemistry, FACS,surface plasmon resonance or chromatography. Methods for these and othertechniques may be found in, for example AUSUBEL et al., CurrentProtocols in Molecular Biology, John Wiley & Sons, New York, N.Y., 1998:ABELOFF, Clinical Oncology, 3^(rd) edition. ChurchillLivingstone/Elsevier Press, 2004; HARLOW, E and LANE D. Antibodies: ALaboratory Manual. 1988. Cold Spring Harbor Laboratory Press; SAMBROOK Jand RUSSELL D W. Molecular cloning: A Laboratory Manual 2001 Cold SpringHarbor Laboratory Press; Harrison's Principles of Internal Medicine15^(th) ed. BRAUNWALD et al eds. McGraw-Hill. 14-3-3 detection methodsare described for example in WO 99/46401, US 2005/9094, WO 97/38315 andWO 97/33601, all of which are incorporated herein be reference.

Western Blotting

Synovial fluid or serum (2 μl of each) was subjected to SDS-PAGEanalysis with 12% (wt/vol) acrylamide gel, and electrotransferred ontoPVDF membranes (Millipore Corporation). Non-specific proteins onmembranes were blocked in 5% skim milk powder in PBS-0.1% Tween-20overnight. Immunoblotting was performed using 2 μg/ml of 7 isoformsspecific rabbit anti-human 14-3-3 polyclonal antibodies (Martin H, PatelY, Jones D, Howell S, Robinson K and Aitken A 1993.

Antibodies against the major brain isoforms of 14-3-3 protein. Anantibody specific for the N-acetylated amino-terminus of a protein. FEBSLetters. 331:296-303). The membranes were then incubated with theappropriate secondary horseradish peroxidise conjugated anti-rabbit IgG(Sigma, St Louis, USA) or anti-mouse IgG (Bio-Rad Laboratories,Hercules, USA) antibodies (1:2500 dilution). Immunoreactive proteinswere then visualized using the ECL+plus western blotting detectionsystem (Amersham Biosciences, Buckinghamshire, England). Keratinocytecell lysate (K) was used as a positive control. SF: synovial fluid; PS:patient serum.

Patient Samples

Synovial fluid was obtained from the knee joints of patients with activesynovitis prior to the institution of anti-TNF therapeutics. Allpatients had a DAS score>6.0. Matched blood samples were obtained bystandard venipuncture procedures. The clot was removed bycentrifugation.

Recombinant 14-3-3 eta

cDNA for keratinocyte-derived 14-3-3 eta was prepared from total RNAextracted from human keratinocytes, cloned and expressed in E. coli, andaffinity purified, following the methods described in Ghahary et al 2004J Invest Dermatol 122:1188-1197. Primers used for PCR amplification ofthe 14-3-3 eta cDNA were SEQ ID NO: 15 (GCGAATTCCTGCAGCGGGCGCGGCTGGCCGA)and SEQ ID NO: 16 (GCTCGAGCCTGAAGGATCTTCAGTTGCCTTC).

Example 1 14-3-3 Expression in Synovial Fluid and Serum of RA AffectedPatients

The levels of the different isoforms of 14-3-3 proteins—β, γ, ε, η, τ σand ζ—in pooled patient synovial fluid (SF) and serum (PS) samples wereanalyzed by western analysis using keratinocyte cell lysate (K) as apositive control. Only the n and γ isoforms were detected in SF samples,and stained with greater intensity compared to PS. Articular jointsynovial fluid samples from 17 RA patients who presented with activesynovitis, but had not yet received anti-TNF therapies also exhibitedconsistent expression of then isoform of 14-3-3 (FIG. 2). All patientshad a disease activity score (DAS) greater than 6.0.

Example 2 MMP Expression in Patient Synovial Fluid Serum

To determine if these variations were correlated to those of MMP-1 andMMP-3 in the same synovial samples, a total of 12 RA synovial fluidsamples and their matched serum samples were simultaneously evaluatedfor 14-3-3η and γ as well as for MMP-1 and MMP-3 proteins (FIG. 3).14-3-3η was detected in all samples. MMP-1 was detected in all samples,both SF and PS, while MMP-3 was more variable in the levels detected.The 14-3-3γ isoform was also detected in patient synovial fluid andserum samples (FIG. 4, 5).

The expression of MMP-1 and MMP-3 demonstrate significant correlationwith the expression of the 14-3-3η and γ isoforms in both synovial fluidand serum (Table 1).

TABLE 1 Correlation of MMP and 14-3-3 protein levels in serum andsynovial fluid. 14-3-3 η 14-3-3 η 14-3-3 γ 14-3-3 γ serum synovium serumsynovium MMP-1 r = 0.62; p = 0.02 r = 0.83; p = 0.03 r = 0.77; p = 0.02r = 0.65; p = 0.03 MMP-3 r = 0.68; p = 0.01 r = 0.77; r = 0.80; p = 0.03r = 0.76; p = 0.04 p = 0.003

Example 3 Sensitivity of Western Blot Detection of 14-3-3 Protein inPatient Serum and Synovial Fluid Samples

To determine the detection level of 14-3-3η in synovial fluid and serumsamples, samples from 12 RA-affected or normal patients were pooled, andlimiting dilutions of the pooled samples were analyzed by western blot.14-3-3η was detectable over a range of dilutions—as low as 0.1 μleffective volume of synovial fluid and 1.0 μl effective volume of serum(FIG. 6A).

2 μl of pooled normal serum (NS) or patient serum (PS) was run alongsideknown concentrations of recombinant 14-3-3η, ranging from 0.05-2.0 μg.The 2 μl volume of NS and PS samples was estimated to have approximately1-1.5 and 15-20 μg of 14-3-3η, respectively (FIG. 6B). This suggeststhat the level of 14-3-3η occurs in about a 10-fold excess in the serumof RA affected patients, compared to normal patients.

Example 4 Detection of 14-3-3η Before and After Anti-TNF Therapy

FIG. 7 illustrates the sequential detection of levels of 14-3-3 etaprotein in 4 ml of serum samples from RA patients before (U) and afteranti-TNF-a (T) Treatment. N=negative control which is 4 ml of a pooledserum sample prepared from 12 serum samples taken from 12 healthyindividuals. P=positive control which is 4 mg of keratinocyte celllysate total protein.

REFERENCES

The following documents are incorporated herein by reference:

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While specific embodiments of the invention have been described andillustrated, such embodiments should be considered illustrative of theinvention only and not as limiting the invention as construed inaccordance with the accompanying claims.

1-13. (canceled)
 14. A method for evaluating an arthritic condition or disease state in a mammalian test subject, comprising: obtaining a test biological sample from said test subject; and detecting at least one 14-3-3 protein isoform in said test sample, wherein said 14-3-3 protein isoform is selected from the group consisting of the 14-3-3 gamma isoform and the 14-3-3 eta isoform.
 15. The method according to claim 14, wherein said detecting step comprises an immunological-based technique.
 16. The method according to claim 15, wherein said immunological-based technique comprises combining said test sample with antibodies specific for said 14-3-3 protein isoform.
 17. The method according to claim 16, wherein said antibodies are specific for the 14-3-3 eta isoform.
 18. The method according to claim 16, wherein said antibodies are specific for the 14-3-3 gamma isoform.
 19. The method according to claim 14, wherein said detecting step comprises mass spectroscopy.
 20. The method according to claim 14, wherein an increased level of said 14-3-3 protein isoform in said test sample in comparison with a control level of said 14-3-3 protein isoform in a suitable control sample is a diagnostic indicator of said arthritic condition or disease state in the test subject.
 21. The method according to claim 14, wherein a test level of said 14-3-3 protein isoform in said test sample, compared with a control level of said 14-3-3 protein isoform in a suitable control sample, is a diagnostic indicator of said arthritic condition or disease state in the test subject.
 22. The method according to claim 14, wherein a decreased level of said 14-3-3 protein isoform in said test sample in comparison with a previously-determined level of said 14-3-3 protein isoform in a previous test sample taken from said test subject is indicative of efficacy of an ongoing therapeutic regimen for the test subject.
 23. The method according to claim 14, wherein said 14-3-3 gamma isoform comprises the amino acid sequence of SEQ ID NO:
 2. 24. The method according to claim 14, wherein said 14-3-3 eta isoform comprises the amino acid sequence of SEQ ID NO:
 3. 25. The method according to claim 14, further comprising detection of at least one additional arthritis marker in said test sample useful for detecting and/or diagnosing an arthritic condition or disease state in the test subject.
 26. The method according to claim 25, wherein said at least one additional arthritis marker is a matrix metalloproteinase.
 27. The method according to claim 14, wherein said arthritic condition or disease state is rheumatoid arthritis.
 28. The method according to claim 14, wherein said test sample is selected from the group consisting of blood, serum, plasma, and synovial fluid.
 29. A method for characterization of arthritis, the method comprising: measuring the expression of at least one 14-3-3 protein isoform in a biological test sample from an individual suspected of having arthritis or an elevated risk of arthritis, wherein increased expression of said at least one 14-3-3 protein isoform in said test sample relative to expression of said 14-3-3 protein isoform in a suitable control sample is a positive indicator of arthritis or elevated risk of arthritis in said individual.
 30. The method according to claim 29, wherein the at least one 14-3-3 protein isoform is detected with antibodies that specifically bind to said 14-3-3 protein isoform.
 31. The method according to claim 30, wherein the antibodies are added to said test sample, and incubated for a period of time sufficient to allow antibody binding to a 14-3-3—protein epitope.
 32. A kit for evaluating/characterizing an arthritic condition in a mammalian subject, comprising at least one reagent that specifically binds to at least one 14-3-3 protein isoform selected from the group consisting of a 14-3-3 gamma isoform and a 14-3-3 eta isoform, together with instructions for using the kit for diagnostic or prognostic purposes.
 33. A kit according to claim 32, comprising a first reagent that specifically binds to a 14-3-3 gamma isoform, and a second reagent that specifically binds to a 14-3-3 eta isoform.
 34. A kit according to claim 32, wherein said reagent is selected from the group consisting of antibodies, organic chemicals, inorganic chemicals, and combinations thereof.
 35. A kit according to claim 32, additionally comprising at least one additional reagent that specifically binds to a matrix metalloproteinase.
 36. A method for determining the efficacy of a therapeutic regimen in an arthritic patient, comprising obtaining a test biological sample from said patient; and detecting in said test sample at least one 14-3-3 protein isoform selected from the group consisting of the 14-3-3 gamma isoform and the 14-3-3 eta isoform; wherein a decreased level of said 14-3-3 protein isoform in said test sample in comparison with a previous sample from said patient is indicative of the efficacy of an ongoing therapeutic regimen.
 37. The method according to claim 36, wherein said detecting step comprises an immunological-based technique.
 38. The method according to claim 36, wherein said immunological-based technique comprises combining said test sample with antibodies specific for said 14-3-3 protein isoform.
 39. The method according to claim 38, wherein said antibodies are specific for the 14-3-3 eta isoform.
 40. The method according to claim 38, wherein said antibodies are specific for the 14-3-3 gamma isoform.
 41. The method according to claim 36, wherein said detecting step comprises mass spectroscopy.
 42. The method according to claim 36, wherein said 14-3-3 gamma isoform comprises the amino acid sequence of SEQ ID NO:
 2. 43. The method according to claim 36, wherein said 14-3-3 eta isoform comprises the amino acid sequence of SEQ ID NO:
 3. 44. The method according to claim 36, further comprising detection of at least one additional arthritis marker in said test sample useful for detecting and/or diagnosing an arthritic condition or disease state in the test subject.
 45. The method according to claim 36, wherein said at least one additional arthritis marker is a matrix metalloproteinase.
 46. The method according to claim 36, wherein said arthritic condition or disease state is rheumatoid arthritis.
 47. The method according to claim 36, wherein said test sample is selected from the group consisting of blood, serum, plasma, and synovial fluid.
 48. A method of detecting the eta isoform of the 14-3-3 protein in a patient, said method comprising: a. obtaining a test sample from a human patient at risk or suspected of having arthritis, wherein the test sample is selected from the group consisting of blood, serum, plasma, and synovial fluid; and b. detecting whether 14-3-3 eta protein is present in the test sample by contacting the test sample with an anti-14-3-3 eta protein antibody and detecting binding between 14-3-3 eta protein and the antibody.
 49. The method according to claim 48, wherein said antibodies are specific for the 14-3-3 eta isoform.
 50. The method according to claim 48, wherein said 14-3-3 eta isoform comprises the amino acid sequence of SEQ ID NO:
 3. 51. The method according to claim 48, further comprising detection of at least one additional arthritis marker in said test sample useful for detecting and/or diagnosing an arthritic condition or disease state in the test subject.
 52. The method according to claim 51, wherein said at least one additional arthritis marker is a matrix metalloproteinase.
 53. The method according to claim 48, wherein said arthritis is rheumatoid arthritis. 